Healthcare Provider Details

I. General information

NPI: 1437992518
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE CENTER OF GAINESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 QUEEN CITY PKWY STE 200
GAINESVILLE GA
30501-4335
US

IV. Provider business mailing address

715 QUEEN CITY PKWY STE 200
GAINESVILLE GA
30501-4335
US

V. Phone/Fax

Practice location:
  • Phone: 678-730-6240
  • Fax:
Mailing address:
  • Phone: 678-730-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX JUTIS
Title or Position: CEO
Credential: DC
Phone: 678-730-6240